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[CSTLTS] Performance Measures to Address COVID-19-Related Health Disparities in Support of the Implementation of the OT21-2103 COVID-19 Health Disparities Grant (carryover to 2023-2025)

IC 258150 under ICR 202507-0920-013 · OMB 0920-1282.

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Form and Instruction
Form and Instruction
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IC Document
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[CSTLTS] Performance Measures to Address COVID-19-Related Health Disparities in Support of the Implementation of the OT21-2103 COVID-19 Health Disparities Grant (carryover to 2023-2025) 0920-22IG
 
Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Modified Reporting Template for CDC OT21-2103 Performance Measures App B_1 Modified Reporting Template CDC OT21-2103_Performance Measures V2 Report.pdf Yes Yes Fillable Fileable

Health Illness Prevention

 

1,296 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,296 0 0 0 0 1,296
Annual IC Time Burden (Hours) 45,360 0 0 0 0 45,360
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GENIC Request Template COVID-19 Disparities (carryover to 2023-2025) PPEO GenIC Request-CDC programs- CSTLTS_OT21-2103_2023-2025.pdf 01/30/2023
Modified Technical Specs and Performance Measures Guidance OT21-2103 App A_Modified Technical Specs CDC OT21-2103 Performance Measure Guidance v2.pdf 01/30/2023
Screenshots OT21-2103 App B_2_CDC OT21-2103_Screenshots OT21-2103.pdf 01/30/2023
Sample Recipient Notification for OT21-2103 CSTLTS_OT21-2103-sample_draft_recipient_notification_ICRO.docx 01/30/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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